Low profile intervertebral implant

ABSTRACT

The present invention is directed to a low profile intervertebral implant for implantation in an intervertebral disc space in-between adjacent vertebral bodies. The intervertebral implant includes a plate preferably coupled to a spacer. The plate is preferably formed from a first material and the spacer is preferably formed from a second material, the first material being different from the second material. The plate is preferably sized and configured so that the plate does not extend beyond the perimeter of the spacer. In this manner, the plate preferably does not increase the height profile of the spacer and the plate may be implanted within the intervertebral disc space in conjunction with the spacer.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/635,480 filed Mar. 2, 2015, which is a continuation of U.S. patentapplication Ser. No. 13/594,965 filed Aug. 27, 2012, now U.S. Pat. No.9,005,295 issued Apr. 14, 2015, which is a continuation of U.S. patentapplication Ser. No. 12/743,098 filed Aug. 25, 2010, now U.S. Pat. No.8,540,774 issued Sep. 24, 2013, which is a U.S. National Phase ofInternational Application No. PCT/US08/82473 filed Nov. 5, 2008, whichclaims priority to U.S. Provisional Patent Application No. 60/988,661,filed Nov. 16, 2007, the contents of which are hereby incorporated byreference in their entireties.

FIELD OF THE INVENTION

The present invention relates to an intervertebral implant. Morespecifically, the preferred embodiment of the present invention relatesto a low profile fusion intervertebral implant for implantation into theintervertebral disc space between adjacent vertebral bodies.

BACKGROUND OF THE INVENTION

Millions of people suffer from back pain. In some instances, in order torelieve back pain and/or to stabilize the spinal structure, it becomesnecessary to fuse adjacent vertebral bodies at one or more levels. Oneknown method for fusing adjacent vertebral bodies is to implant one ormore intervertebral implants into the affected disc space.

SUMMARY OF THE INVENTION

A preferred embodiment of the present invention is directed to a lowprofile intervertebral implant for implantation in an intervertebraldisc space between adjacent vertebral bodies. The intervertebral implantincludes a plate preferably coupled to a spacer. The plate is preferablysized and configured so that the plate does not extend beyond theperimeter of the spacer. In this manner, the plate preferably does notincrease the height profile of the spacer and the plate may be implantedwithin the intervertebral disc space in conjunction with the spacer.

In another aspect of the preferred embodiment of the intervertebralimplant, the plate is coupled to the spacer by one or more armsextending from the plate. The arms are sized and configured tosubstantially surround and receive the spacer so that the spacer issecurely coupled to the plate. The one or more arms may be acircumferential arm that extends from the plate and which completelywraps around the spacer. The circumferential arm may be sized andconfigured to shrink as a result of temperature variation.Alternatively, the arms may be a plurality of deformable arms sized andconfigured to receive the spacer. The arms are preferably deformable tosubstantially surround and compress against the spacer to secure thespacer to the arms. Alternatively, the one or more arms may beselectively interconnected with one another so that the first and secondarms may be placed around the spacer and then tightened to operativelycouple the spacer to the plate.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofthe preferred embodiments of the application, will be better understoodwhen read in conjunction with the appended drawings. For the purposes ofillustrating the preferred intervertebral implants of the presentapplication, there is shown in the drawings preferred embodiments. Itshould be understood, however, that the application is not limited tothe precise arrangements and instrumentalities shown. In the drawings:

FIG. 1A illustrates a rear perspective view of an intervertebral implantin accordance with a first preferred embodiment of the presentinvention;

FIG. 1B illustrates a top perspective view of the intervertebral implantshown in FIG. 1A;

FIG. 2 illustrates a front perspective view of an intervertebral implantin accordance with a second preferred embodiment of the presentinvention;

FIG. 3A illustrates a rear perspective view of an intervertebral implantin accordance with a third preferred embodiment of the presentinvention;

FIG. 3B illustrates a front perspective view of the intervertebralimplant shown in FIG. 3A;

FIG. 4A illustrates a top perspective view of an intervertebral implantin accordance with a fourth preferred embodiment of the presentinvention;

FIG. 4B illustrates a bottom plan view of the intervertebral implantshown in FIG. 4A;

FIG. 5 illustrates a partially exploded top perspective view of anintervertebral implant in accordance with a fifth preferred embodimentof the present invention;

FIG. 6 illustrates a partially exploded side perspective view of anintervertebral implant in accordance with a sixth preferred embodimentof the present invention;

FIG. 6A illustrates a cross-sectional view of the intervertebral implantshown in FIG. 6, taken along line 6 a-6 a in FIG. 6 with theintervertebral implant in an assembled configuration;

FIG. 7 illustrates a front perspective view of an intervertebral implantin accordance with a seventh preferred embodiment of the presentinvention;

FIG. 8 illustrates a rear perspective view of an intervertebral implantin accordance with an eighth preferred embodiment of the presentinvention;

FIG. 9 illustrates a rear perspective view of an intervertebral implantin accordance with an ninth preferred embodiment of the presentinvention;

FIG. 10 illustrates a rear elevational view of an intervertebral implantin accordance with a tenth preferred embodiment of the presentinvention, wherein the intervertebral implant is mounted to a spine;

FIG. 11 illustrates a rear perspective view of an intervertebral implantin accordance with an eleventh preferred embodiment of the presentinvention; and

FIG. 12 illustrates a rear perspective view of an intervertebral implantin accordance with a twelfth preferred embodiment of the presentinvention.

DETAILED DESCRIPTION OF THE INVENTION

Certain terminology is used in the following description for convenienceonly and is not limiting. The words “right”, “left”, “top” and “bottom”designate directions in the drawings to which reference is made. Thewords “inwardly” and “outwardly” refer to directions toward and awayfrom, respectively, the geometric center of the device and designatedparts thereof. The words, “anterior”, “posterior”, “superior”,“inferior” and related words and/or phrases designate preferredpositions and orientations in the human body to which reference is madeand are not meant to be limiting. The terminology includes theabove-listed words, derivatives thereof and words of similar import.

Referring to FIGS. 1A-12, certain exemplary embodiments of the inventionwill now be described with reference to the drawings. In general, suchembodiments relate to a low profile intervertebral implant 10. It shouldbe understood that while the various embodiments of the intervertebralimplant 10 will be described in connection with spinal surgery, thoseskilled in the art will appreciate that the intervertebral implant 10 aswell as the components thereof may be used for implantation into otherparts of the body. The same reference numerals will be utilizedthroughout the application to describe similar or the same components ofeach of the twelve preferred embodiments of the preferred intervertebralimplants described herein and the descriptions will focus on thespecific features of the individual embodiments that distinguish theparticular embodiment from the others.

Generally speaking, the various embodiments of the intervertebralimplant 10 are sized and configured to be implanted between adjacentvertebral bodies V. The intervertebral implants 10 may be sized andconfigured to replace all or substantially all of an intervertebral discspace D between adjacent vertebral bodies V or only part of theintervertebral disc space D. In addition, the preferred intervertebralimplants 10 may be configured to replace an entire vertebral body V andrelated disc spaces D or multiple disc spaces D in a patient's spine, asis apparent to one having ordinary skill in the art.

The intervertebral implants 10 of each of the preferred embodimentspreferably include a plate 40 and a spacer 20. The spacer 20 may includea first insertion end portion 22 (e.g., front end), a second end portion24 (e.g., rear end) opposite the first insertion end portion 22, a firstlateral end 26, a second lateral end 28, an upper surface 30, and alower surface 32. The spacer 20 is preferably configured and dimensionedfor implantation into the intervertebral disc space D between adjacentvertebral bodies V. The spacer 20 is preferably sized and configured tomaintain and/or restore a desired intervertebral disc height H betweenthe adjacent vertebral bodies V.

The plate 40 is preferably mounted to the second end portion 24 of thespacer 20 and preferably does not extend beyond the perimeter of thespacer 20. That is, a plate height h_(p) of the plate 40 is preferablyno more than a spacer height h_(s) of the spacer 20 at the second end 24so that the plate 40 does not increase the height profile of the spacer20. In this manner, the intervertebral implant 10 has a low profile.Additionally, in this manner, the plate 40 may be entirely implantedinto the intervertebral disc space D between the adjacent vertebralbodies V such that the plate 40 does not extend beyond an edge of thedisc space D.

The upper and lower surfaces 30, 32 of the spacer 20 may include aseries of teeth, one or more keels, or other similar projections (notshown) to aid in securing the intervertebral implant 10 to the endplatesof the adjacent vertebral bodies V. Alternatively or in addition, thespacer 20 may include one or more windows or channels (not shown)designed to receive bone graft material. For example, the spacer 20 mayinclude one or more vertical windows or channels (not shown) extendingthrough the spacer 20 from the upper surface 30 to the lower surface 32for insertion of bone graft material such that bone growth is promotedthrough the vertical windows or channels following implantation of theintervertebral implant 10. Alternatively or in addition, the spacer 20may have one or more horizontal windows or channels (not shown)extending through the spacer 20 from the first lateral end 26 to thesecond lateral end 28 for receiving bone graft material.

The upper and lower surfaces 30, 32 of the spacer 20 may include acurved or a tapered surface to help provide the proper shape to thespine or to orient the endplates of the adjacent vertebral bodies V in adesired manner. The particular surface shape and curvature or taper inthe anterior-posterior direction as well as between the first and secondlateral ends 26, 28 will depend upon the location the implant 10 isintended to be implanted and/or surgeon preferences.

The intervertebral implant 10 may be constructed of any suitablematerial or combination of materials including, but not limited topolymer (e.g. PEEK), titanium, titanium alloy, stainless steel, Nitinol,tantalum nitride (TaN), allograft bone, bioresorbable material,magnesium, composites, synthetic bone-welding polymers, etc. The plate40 may be formed of a different material than the spacer 20. Forexample, the plate 40 may be formed of a metallic material such as, forexample, a titanium or a titanium alloy, and the spacer 20 may be formedof a non-metallic material such as, for example, an allograft, apolymer, a bioresorbable material, a ceramic, etc. Alternatively, theplate 40 and the spacer 20 may be formed from the same material. Forexample, the plate 40 and the spacer 20 may both be constructed oftantalum nitride (TaN).

The plate 40 preferably includes one or more through holes 42 forreceiving fasteners 75 such as, for example, one or more bone screws 75,for securing the intervertebral implant 10 to the adjacent vertebralbodies V. The plate 40 may include any number of through holes 42arranged in any number of combinations. For example, the plate 40 mayinclude two, three, four or more through holes 42 for receiving,preferably, an equal number of bone screws 75. Moreover, the throughholes 42 may alternate with one another with one through hole 42 beingangled up and the next through hole 42 being angled down (FIGS. 8 and9), or the through holes 42 on the outside may be angled up while thethrough holes 42 on the inside may be angled down (FIGS. 5-7, 11 and12), etc.

The plate 40 of the preferred embodiments includes at least two throughholes 42 configured to receive two fasteners 75 for securing theintervertebral implant 10 to the adjacent vertebral bodies V. The atleast two through holes 42 preferably diverge so that at least onefastener 75 is secured into the upper vertebral body V while at leastone other fastener 75 is secured into the lower vertebral body V so thatopposing forces act on the plate 40 and/or vertebral bodies V.Alternatively, the plate 40 may include three through holes 42configured to receive three fasteners 75. One fastener 75 may penetratethe upper vertebral body V and two fasteners 75 may penetrate the lowervertebral body V, or vice versa. Alternatively, the plate 40 may includefour or more through holes 42 configured to receive four or morefasteners 75. In such a configuration, two inner fasteners 75 maypenetrate the upper vertebral body V while two outer fasteners 75 maypenetrate the lower vertebral body V, or vice versa, or some combinationthereof.

The through holes 42 each include a hole axis 43 such that one of theholes 42 exit through the upper surface of the intervertebral implant10, possibly through the upper surface 30, for engaging the uppervertebral body V while another of the holes 42 exit through the lowersurface of the intervertebral implant 10, possibly through the lowersurface 32 for engaging the lower vertebral body V. The fastener 75 thatextends through the hole 42, preferably along the hole axis 43 forms afastener angle α with respect to the upper and lower surfaces 30, 32 ofthe spacer 20 wherein fastener angle α may be in the range betweentwenty degrees (20°) and fifty degrees (50°), and most preferablybetween thirty degrees (30°) and forty-five degrees (45°). The fastenerangle α may be the same for all of the holes 42 or may be different foreach of the holes 42.

The through holes 42 formed in the plate 40 preferably are directedoutwardly from the center of the intervertebral implant 10, preferablyat a lateral fastener angle Ω. Thus, the through holes 42 preferablyextend laterally outward from a center plane 11 of the intervertebralimplant 10 at the lateral fastener angle Ω. The lateral fastener angle Ωmay be the same for all holes 42 or may be different for each hole 42.

Exit openings 42 a of the through holes 42 may be formed in the plate 40or in the spacer 20. The through holes 42 may also include one or morethreads (not shown) for threadably engaging threads formed on a headportion 75 a of the bone screw 75 in order to secure the bone screws 75to the plate 40 and to generally lock the position of the bone screws 75relative to the plate 40 and/or spacer 20.

The intervertebral implant 10 of the preferred embodiments alsopreferably includes a coupling mechanism 100 for securing the plate 40to the spacer 20. Generally speaking, the spacer 20 and the plate 40 arecoupled together by the coupling mechanism 100 prior to being implantedinto the disc space D. However, in certain embodiments, theintervertebral implant 10 may be configured so that the plate 40 may becoupled to the spacer 20 after one of the spacer 20 and plate 40 havebeen implanted into the intervertebral disc space. Once coupled, thespacer 20 and plate 40 preferably form a solid implant. The couplingmechanism 100 may be any of the coupling mechanisms 100 described hereinor their structural equivalents.

Referring to a first preferred embodiment of the intervertebral implant10 shown in FIGS. 1A and 1B, the coupling mechanism 100 may be in theform of a solid, circumferential arm 102 that extends from the plate 40.The circumferential arm 102 is preferably sized and configured to wraparound and/or to receive the spacer 20 therein. Preferably, the spacer20 includes a recess 36 formed on the outer surfaces thereof forreceiving at least a portion of the circumferential arm 102.

The circumferential arm 102 may be made from a material that deforms orshrinks as a result of being heated or cooled such as, for example,Nitinol or any other suitable material that deforms as a result oftemperature variation. In this manner, the plate 40 may be fixed to thespacer 20 by heating or cooling the plate 40, thereby causing the arm102 of the plate 40 to shrink, which in turn causes the arm 102 tocircumferentially engage the spacer 20. This first preferred embodimentof the intervertebral implant 10 is particularly useful since it enablesrelatively loose tolerances during manufacturing of the spacer 20.

Referring to a second preferred embodiment of the intervertebral implant10 shown in FIG. 2, the coupling mechanism 100 may be in the form of asplit ring 110. That is, the plate 40 may include a pair of arms 112,114 extending therefrom, wherein the arms 112, 114 are sized andconfigured to substantially surround the outer circumference of thespacer 20 in order to couple the spacer 20 to the plate 40. The arms112, 114 are preferably configured so as to be deformable around thespacer 20. That is, the arms 112, 114 are preferably able to deform sothat the arms 112, 114 can wrap around and/or squeeze the spacer 20. Theintervertebral implant 10 of the second preferred embodiment is notlimited to having the pair of arms 112, 114 and may include nearly anynumber of arms extending from the plate 40 that are deformable to engageand secure the spacer 20 relative to the plate 40.

As best shown in FIG. 2, the split ring 110 may be include an open gap116 proximate the first insertion end portion 22 of the implant 10 thatdefines terminal ends 112 a, 114 a of the arms 112, 114. The endportions of the arms 112, 114 proximate the terminal ends 112 a, 114 aare preferably deformable to permit manual clamping of the spacer 20with the arms 112, 114 to secure the spacer 20 to the plate 40. The gap116 is not limited to being positioned generally along a midline of thespacer 20 opposite the plate 40 and may be located at nearly anyposition relative to the plate 40 that permits the arms 112, 114 todeform and clamp or otherwise secure the spacer 20 to the plate 40. Forexample, the gap 116 may be positioned proximate a corner of thepreferred spacer 20 proximate an intersection of the first insertion endportion 22 and one of the first and second lateral ends 26, 28

Referring to FIGS. 3A and 3B, in a third preferred embodiment of theintervertebral implant 10, the split ring 110′ may be sized andconfigured so that the arms 112′, 114′ may be interconnected to oneanother at their terminal ends 112 a′, 114 a′ so that, in use, the splitring 110′ may be placed around the spacer 20 and then tightened tooperatively couple the plate 40 to the spacer 20. The interconnectedarms 112′, 114′ of the split ring 110′ of the third preferred embodimentmay be tighten by any means including but not limited to a ratchetinglocking mechanism 118, a hose clamp design, etc. Incorporation of thesplit ring 110′ of the third preferred embodiment enables the plate 40to accommodate spacers 20 of variable dimensions and compositions.Furthermore, incorporation of the split ring 110′ of the third preferredembodiment may enable the intervertebral implant 10 to be assembled insitu. Other, alternate designs of the plate 40 that allow for thecoupling of the plate 40 around the spacer 20 are envisioned.Alternatively, incorporation of the split ring 110′ of the thirdpreferred embodiment may enable the surgeon to incorporate bone packingmaterial as opposed to a pre-formed spacer 20 as described herein and aswould be apparent to one having ordinary skill in the art.

Referring to the fourth preferred embodiment of the intervertebralimplant 10 shown in FIGS. 4A and 4B, the coupling mechanism 100 may bein the form of a recess 120 preferably extending from the upper surface30 to the lower surface 32 of the spacer 20 to engage a projection 122formed on and extending from the plate 40 in an assembled configuration.The recess 120 may be formed in the first and second lateral ends 26, 28of the spacer 20, in only one of the first and second lateral ends 26,28, centrally within the spacer 20 or otherwise formed for engagement bythe projection 122. For example, as shown, the coupling mechanism 100 ofthe fourth preferred embodiment is in the form of a dovetail joint,wherein the recess 120 is comprised of recesses 120 extending from thetop surface 30 toward the bottom surface 32 proximate the second end 24and the first and second lateral ends 26, 28, respectively. In thisfourth preferred embodiment, the coupling mechanism 100 preferablyenables the plate 40 to unidirectionally, slidably engage the spacer 20by sliding the projection 122 into the recess 120, wherein theprojection 122 and recess 120 are formed to prevent the spacer 20 frombeing engaged with the plate 40 unless the spacer 20 is aligned with theplate 40 and slides along a unitary engagement direction. Alternatively,the projection 122 formed on the plate 40 may be sized and configured toflex across the spacer 20 until the projections 122 substantially fitinside the recesses 120 thereby coupling the spacer 20 to the plate 40via a press-fit arrangement. It should be appreciated that the locationsof the projections 122 and the recesses 120 may be reversed so that thespacer 20 includes the projections and the plate 40 includes therecesses, respectively. In addition, the projections 122 and recesses120 are preferably sized to align the spacer 20 with the plate 40 suchthat the top surface 30 of the spacer 20 is generally coplanar with atop surface 40 a of the plate 40 and a bottom surface 32 of the spacer20 is generally coplanar or aligned with a bottom surface 40 b of theplate 40 in the assembled configuration. Specifically, the projections122 and the recesses 120 may be tapered to promote the unitary insertionof the spacer 20 into engagement with the plate 40 and alignment of thetop and bottom surfaces 40 a, 40 b of the plate 40 with the top andbottom surfaces 30, 32 of the spacer 20 in the assembled configuration.

In addition, the coupling mechanism 100 of the fourth preferredembodiment may include one or more rotatable cams 125, preferablycoupled to the plate 40 to lock the spacer 20 to the plate 40 after thespacer 20 is slid onto the plate 40. Alternatively, the one or morerotatable cams 125 may act as a depth stop to prevent the plate 40 andthe spacer 20 from sliding completely past one another as the spacer 20slides onto the plate 40 to engage the projections 122 with the recesses120, respectively. The cam 125 may be included on either or both of theupper and lower surfaces of either or both of the plate 40 and spacer20. Preferably, for example, the plate 40 may include one or more cams125 on the upper and lower surfaces of the plate 40, wherein the cam 125is sized and configured to engage one or more recesses 126 formed on theupper and lower surfaces 30, 32 of the spacer 20. In use, the plate 40and the spacer 20 may be coupled to each other by rotation of the cam125, which may be accomplished by hand or with the benefit of a tool.

Referring to the fifth preferred embodiment of the intervertebralimplant 10 shown in FIG. 5, the coupling mechanism 100 may include ascrew 130 that is sized and configured to mate with a nut or barrelthreaded pin 132 through first and second holes 20 a, 40 c in the spacer20 and the plate 40, respectively. The screw 130 preferably is sized andconfigured to mate with the nut or barrel threaded pin 132, which may beinserted from the opposite side of the intervertebral implant 10 tosecure the spacer 20 to the plate 40. In use, the screw 130 isthreadably engaged to the nut or barrel threaded pin 132, therebycoupling the spacer 40 to the plate 20. As best shown in FIGS. 6 and 6Ain a sixth preferred embodiment of the intervertebral implant 10, thescrew 130′ may be cannulated to allow inclusion and use of a blockingplate 134 and a set screw 136 to prevent “backing-out” of the fasteners75.

Referring to the seventh preferred embodiment of the intervertebralimplant 10 shown in FIG. 7, the coupling mechanism 100 may be in theform of a swag plate 140 that extends into and engages the distal end ofan aperture 142 formed in the spacer 20. The plate 40 comprises two arms144, 146 in the preferred embodiment that extend from the plate 40 intothe aperture 142. In use, the arms 144, 146 may be urged together attheir distal ends and inserted into the aperture 142 until the ends ofthe arms 144, 146 extend through the aperture 142, at which point, thearms 144, 146 are released so that the ends of the arms 144, 146,preferably protrusions formed thereon, engage the distal end of theaperture 142 of the spacer 20. The arms 144, 146 are able to flex orbend proximate their root or proximal ends such that the distal ends ofthe arms 144, 146 are able to slide through the aperture 142 duringassembly. This embodiment enables the plate 40 to engage the spacer 20from the inside out. In use, this embodiment enables a relatively simpleassembly that permits visualization of the anterior/posterior depth ofthe implant 10 on an X-ray and assembly of the implant 10 in theoperating room.

Referring to the eighth preferred embodiment of the intervertebralimplant 10 shown in FIG. 8, the spacer 20 may have a generallyrectangular or square-shape with the plate 40 mounted proximate a cornerof the spacer 20. The plate 40 may be coupled to the spacer 20 by anycoupling mechanisms 100 now or hereafter known for such purposeincluding those described herein. In use, coupling the plate 40 to acorner of the spacer 20, as opposed to one of the long ends, facilitatesimplanting of the intervertebral implant 10 into the disc space via anoblique angle. This embodiment is preferably used in cervicalapplications to limit distract the esophagus, via the approach.

Referring to the ninth preferred embodiment of the intervertebralimplant 10 shown in FIG. 9, the intervertebral implant 10 includes arelatively narrow lateral footprint. In use, incorporating a narrowerlateral footprint enables the intervertebral implant 10 to accommodatesmaller sized patients and/or permits smaller incisions to facilitateminimally invasive techniques. The intervertebral implant 10 of theninth preferred embodiment may be used as a strut so that the remainderof the area around the implant 10 may be packed with bone chips, putty,bone cement, etc. The intervertebral implant 10 of the ninth preferredembodiment may also enable a transpedicular posterior approach. Theintervertebral implant 10 may be used for corpectomy as well asdiscectomy. It should be noted that any of the embodiments disclosedherein may be sized and configured to include a narrower lateralfootprint.

Alternatively and/or in addition, as best shown in FIG. 10, a tenthpreferred embodiment of the intervertebral implant 10 includes the plate40 mounted to two spacers 20 such that the implant 10 is able to spanone or more vertebral bodies V.

Referring to the eleventh preferred embodiment of the intervertebralimplant 10 shown in FIG. 11, the plate 40 may be implanted betweenadjacent vertebral bodies without a spacer 20 coupled thereto so thatthe plate 40 may be implanted between adjacent vertebral bodies tomaintain the height of the disc space while leaving the surgeon theoption as to whether or not to insert an uncoupled spacer 40, bonechips, bone cement, etc. into the remaining portion of theintervertebral disc space D.

The various coupling mechanisms 100 disclosed herein may also include anadhesive bonding for additional coupling of the plate 40 to the spacer20. That is, various methods of bonding the spacer 20 to the plate 40may be used in connection with the various coupling mechanisms 100disclosed herein. These methods, may include, but are not limited to,chemical bonding or process, ultrasound, ultraviolet light, adhesives,bone welding, clamping etc. These methods may be used in addition, orinstead of other coupling mechanisms 100.

Furthermore, referring to a twelfth preferred embodiment of theintervertebral implant 10 shown in FIG. 12, the intervertebral implant10 may be constructed completely of a monolithic material and has angledbores and fasteners 75. The implant 10 and the fasteners 75 arepreferably constructed of the same material, which may be, but is notlimited to PEEK, titanium, a resorbable polymer, or magnesium. Theimplant 10 of the twelfth preferred embodiment may be constructedexclusively of a resorbable material that completely resorbes into apatient's body following implantation. Preferably, the intervertebralimplant 10 of the twelfth preferred embodiment is made from an allograftmaterial. The intervertebral implant 10 of the twelfth preferredembodiment may be constructed such that the fasteners 75 are formed fromsynthetic bone material, which may be inserted and thereafter welded tothe adjacent vertebral bodies V to thereby couple the intervertebralimplant 10 to the adjacent vertebral bodies V. Alternatively, thesynthetic bone material fasteners 75 may be constructed without threadsin the form of pins. Such synthetic bone fasteners 75 may benon-threaded or include, for example, push-out resistant Christmas treethreads or other types of threads. Incorporation of synthetic bonematerial fasteners 75 facilitates manufacturing of the intervertebralimplant 10 by eliminating metallic components from the implant 10,thereby enabling constructions using exclusively allograft or resorbablematerials.

Alternatively, the intervertebral implant 10 of the twelfth preferredembodiment may incorporate a plate 40 coupled to the spacer 20 andwelded to the synthetic bone material fasteners 75 by, for example,ultrasound, thereby eliminating the need for any mechanical lockingmechanism when the fasteners are mounted in the through holes 42 in animplanted position. In use, manufacturing the spacer 20 from anallograft or resorbable material and incorporating synthetic bonematerial fasteners 75 results in only the plate remaining within thepatient, if any component of the implant 10 remains within the patient,due to the materials resorbing into the patient's body. It should benoted, however, that it is envisioned that synthetic bone materialfasteners 75, which may be welded in-situ to the adjacent vertebralbodies V, may be used in connection with any of the intervertebralimplants 10 now or hereafter known including any of the variousembodiments of the implant 10 described herein.

The intervertebral implants 10 of each of the twelve preferredembodiments are generally sized and configured for anterior insertion,although different configurations may be possible for lateral,antero-lateral or posterior approaches. In addition to the featuresdescribed, the intervertebral implant 10 may include threaded holes,slots or channels to mate with instruments to facilitate manipulationand insertion.

Although the present invention and its advantages have been described indetail, it should be understood that various changes, substitutions, andalterations can be made herein without departing from the spirit andscope of the invention as defined by the appended claims. Moreover, thescope of the present application is not intended to be limited to theparticular embodiments of the process, machine, manufacture, compositionof matter, means, methods and steps described in the specification. Asone of ordinary skill in the art will readily appreciate from thedisclosure of the present invention, processes, machines, manufacture,composition of matter, means, methods, or steps, presently existing orlater to be developed that perform substantially the same function orachieve substantially the same result as the corresponding embodimentsdescribed herein may be utilized according to the present invention.

It will be appreciated by those skilled in the art that variousmodifications and alterations of the invention can be made withoutdeparting from the broad scope of the appended claims. Some of thesehave been discussed above and others will be apparent to those skilledin the art. For example, the present invention may be employed indifferent sections of the spinal column, including, but not limited to,the cervical area.

The invention claimed is:
 1. A plate configured to be coupled to aspacer to form an intervertebral implant that is insertable into anintervertebral disc space defined by a first vertebral body and a secondvertebral body, the plate comprising: a body portion including a firstsurface and a second surface offset from the first surface in a firstdirection, the body portion defining a first hole having a first entryopening with an enclosed shape defined by the first surface and a firstexit opening defined at least partially by the second surface, at leasta portion of the first exit opening offset from the first entry openingwith respect to a second direction that is oblique to the firstdirection such that the first hole is configured to receive a bonefixation element that secures the plate to one of the first vertebralbody and the second vertebral body, the body portion defining a secondhole having a second entry opening with an enclosed shape defined by thefirst surface and a second exit opening defined at least partially bythe second surface, at least a portion of the second exit opening offsetfrom the second entry opening with respect to a third direction that isoblique to the first direction such that the second hole is configuredto receive a bone fixation element that secures the plate to the otherof the first vertebral body and the second vertebral body, the bodyportion further including a top surface and a bottom surface, the bottomsurface offset from the top surface in a fourth direction that isperpendicular to the first direction, the top surface configured to abutthe first vertebral body when the intervertebral implant is insertedinto the intervertebral disc space, and the bottom surface configured toabut the second vertebral body when the intervertebral implant isinserted into the intervertebral disc space, wherein an entirety of boththe first entry opening and the second entry opening are positionedbetween the top surface and the bottom surface; a first arm that extendsfrom the body portion and terminates at a first end such that a portionof the first arm is offset from the second surface in the firstdirection, the portion of the first arm including a first arm topsurface and a first arm bottom surface offset from the first arm topsurface in the fourth direction, wherein the first end comprises a firstplurality of teeth that are linearly arranged and disposed between thetop and bottom surfaces of the body portion; and a second arm thatextends from the body portion and terminates at a second end such that aportion of the second arm is offset from the second surface in the firstdirection, and the second end comprises a second plurality of teeth thatface the first plurality of teeth, are linearly arranged, and aredisposed between the top and bottom surfaces of the body portion,wherein respective terminal surfaces of the first and second ends arespaced from each other by a distance measured in a fifth direction thatis perpendicular to both the first direction and the fourth direction,wherein the first arm and the second arm are sized and configured tosecurely receive and couple the spacer to the plate, the body portiondefines a first height measured from the top surface of the body portionto the bottom surface of the body portion in the fourth direction, theportion of the first arm defines a second height measured from the firstarm top surface to the first arm bottom surface in the fourth direction,and the first height is greater than the second height, and wherein atleast a portion of the first entry opening is aligned with at least aportion of the second entry opening with respect to the fifth direction.2. The plate of claim 1, wherein the first height is measured along thefirst surface, the first arm extends from the second surface in thefirst direction, the first arm projects inward toward the second arm soas to define the first end of the first arm, and the second height ismeasured at the first end of the first arm.
 3. The plate of claim 1,wherein the first height is a maximum height of the body portion, andthe second height is a minimum height of the first arm.
 4. The plate ofclaim 3, wherein the portion of the second arm includes a second arm topsurface and a second arm bottom surface offset from the second arm topsurface in the fourth direction, the portion of the second arm defines athird height measured from the second arm top surface to the second armbottom surface in the fourth direction, and the first height is greaterthan the third height.
 5. The plate of claim 4, wherein when the plateis coupled to the spacer, the intervertebral implant is configured to beinserted in the intervertebral disc space such that the second arm topsurface faces the first vertebral body and the second arm bottom surfacefaces the second vertebral body.
 6. The plate of claim 5, wherein whenthe plate is coupled to the spacer, the intervertebral implant isconfigured to be inserted in the intervertebral disc space such that thesecond arm top surface abuts the first vertebral body and the second armbottom abuts the second vertebral body.
 7. The plate of claim 5, whereinthe second height is equal to the third height.
 8. The plate of claim 5,wherein the third height is a minimum height of the second arm.
 9. Theplate of claim 5, wherein the top surface, the first arm top surface,and the second arm top surface each are configured to face the firstvertebral body when the plate is coupled to the spacer and theintervertebral implant is inserted in the intervertebral disc space, andthe bottom surface, the first arm bottom surface, and the second armbottom surface each are configured to face the second vertebral bodywhen the plate is coupled to the spacer and the intervertebral implantis inserted in the intervertebral disc space.
 10. The plate of claim 5,wherein the first arm includes a first sidewall and a second sidewallthat is opposite the first sidewall, the second arm includes a firstsidewall that faces the first sidewall of the first arm, the second armfurther includes a second sidewall opposite the first sidewall of thesecond arm, and the second sidewall of the first arm converges towardthe second sidewall of the second arm as the first arm extends in thefirst direction.
 11. The plate of claim 5, wherein both the portion ofthe first arm and the portion of the second arm are offset from thefirst exit opening in the first direction.
 12. The plate of claim 1,wherein the second height is measured from a first location on the firstarm top surface to a second location on the first arm bottom surface,and the first arm top surface is parallel to the first arm bottomsurface.
 13. A plate configured to be coupled to a spacer to form anintervertebral implant that is configured to be inserted in anintervertebral disc space that is defined by a first vertebral body anda second vertebral body, the plate comprising: a body portion includinga first surface and a second surface offset from the first surface in afirst direction, the body portion defining a first hole having a firstentry opening with an enclosed shape defined by the first surface and afirst exit opening, at least a portion of the first exit opening offsetfrom the first entry opening with respect to a second direction that isoblique to the first direction such that the first hole is configured toreceive a bone fixation element that secures the plate to the firstvertebral body, the body portion defining a second hole having a secondentry opening with an enclosed shape defined by the first surface and asecond exit opening, at least a portion of the second exit openingoffset from the second entry opening with respect to a third directionthat is oblique to the first direction such that the second hole isconfigured to receive a bone fixation element that secures the plate tothe second vertebral body, the body portion further including a topsurface and a bottom surface offset from the top surface in a fourthdirection that is perpendicular to the first direction, the top surfaceconfigured to face the first vertebral body when the plate is insertedin the intervertebral disc space, the bottom surface configured to facethe second vertebral body when the plate is inserted in theintervertebral disc space, wherein a portion of the first entry openingis closer to the top surface than an entirety of the second entryopening is to the top surface; a first arm attached to the body portionsuch that the first arm extends from the second surface in the firstdirection and terminates at a first end, the first arm including a firstportion and a second portion offset from each other along the firstdirection, the first portion including a first top arm surface and afirst bottom arm surface offset from the first top arm surface in thefourth direction, the second portion including a second top arm surfaceand a second bottom arm surface offset from the second top arm surfacein the fourth direction, the first arm configured such that when theplate is inserted in the intervertebral disc space the first top armsurface and the second top arm surface each face the first vertebralbody and the first bottom arm surface and the second bottom arm surfaceeach face the second vertebral body; and a second arm that extends fromthe body portion and terminates at a second end, such that respectiveend surfaces of the first and second ends are separated from each otherby a distance measured in a fifth direction that is perpendicular toboth the first direction and the fourth direction, wherein the first endand the second end comprise respective linear arrays of teeth that faceeach other and are disposed between the top surface and the bottomsurface of the body portion, wherein the first portion defines a firstheight measured from the first top arm surface to the first bottom armsurface in the fourth direction, the second portion defines a secondheight measured from the second top arm surface to the second bottom armsurface in the fourth direction, and the first height is greater thanthe second height, and wherein at least a portion of the first entryopening is aligned with at least a portion of the second entry openingwith respect to the fifth direction.
 14. The plate of claim 13, whereinboth the first portion and the second portion are offset from the exitopening in the first direction.
 15. The plate of claim 13, wherein thebody portion defines a third height measured from the top surface to thebottom surface in the fourth direction, and the third height is greaterthan the second height.
 16. The plate of claim 13, wherein the secondarm is offset from the first arm by a gap that is configured to receivethe spacer.
 17. The plate of claim 13, wherein the second arm includes athird portion and a fourth portion offset from each other along thefirst direction, the third portion including a third top arm surface anda fourth bottom surface offset from the third top arm surface in thefourth direction, the fourth portion including a fourth top arm surfaceand a fourth bottom surface offset from the fourth top arm surface inthe fourth direction, the second arm configured such that when the plateis inserted in the intervertebral disc space the third top arm surfaceand the fourth top arm surface each face the first vertebral body andthe third bottom surface and the fourth bottom surface each face thesecond vertebral body.
 18. The plate of claim 17, wherein the thirdportion defines a third height measured from the third top arm surfaceto the third bottom surface in the fourth direction, the fourth portiondefines a fourth height measured from the fourth top arm surface to thefourth bottom surface in the fourth direction, and the third height isgreater than the fourth height.
 19. The plate of claim 18, wherein thebody portion defines a fifth height measured from the top surface to thebottom surface in the fourth direction, the fifth height is greater thanthe second height, and the fifth height is greater than the fourthheight.
 20. The plate of claim 18, wherein each of the first portion,the second portion, the third portion, and the fourth portion are offsetfrom the exit opening in the first direction.
 21. The plate of claim 18,wherein the first arm includes a first sidewall and a second sidewallthat is opposite the first sidewall, the second arm includes a firstsidewall that faces the first sidewall of the first arm, the second armfurther includes a second sidewall opposite the first sidewall of thesecond arm, and the second sidewall of the first arm converges towardthe second sidewall of the second arm as the first arm extends in thefirst direction.